Epidural application of bupivacaine hasbeen suggested to have a sympatholytic effect on spinal reflexmechanisms that shortens postoperative paralysis and leads to animproved transit time. The influence on anastomitic healing remainscontroversial. Laparotomy was performed in eight dogs. A short segmentof the distal colon was resected and five electrodes were fixed on theserosa to measure the myoelectric activity (e.g., Migrating MyoelectricComplex—MMC). After operation a peridural catheter was placed betweenL7 and the sacral crest. One milliliter of bupivacaine 0.25% for each3 kg of body weight was injected every 4 hours. Barium pellets coatedin wax were placed into the stomach to allow radiographicrepresentation of transit time. After 5 days the colon anastomosis wasresected to measure the bursting pressure. In the peridural analgesiagroup (PDA) we found one small bowel intussusception and one coveredanastomotic leakage. Postoperative PDA led to early and severemyoelectric activity but did not influence the time until the first MMCoccurred (44 ± 0.8 h, PDA; 44.6 ± 1.5 h,control). Neither the transit time to the colon (50.2 ± 1.9h, PDA; 51.7 ± 5.5 h, control) nor the anastomotic healingwas influenced (bursting pressure: 176 ± 21.1 mmHg, PDA; 152± 27.7 mmHg, control). Postoperative epidural analgesia withbupivacaine shortens intestinal paralysis. Early myoelectric activitywith a lack of propulsive activity can cause complications like smallbowel intussusception. Hence early postoperative enteral nutritionafter epidural analgesia is risky. Because the influence of epiduralanalgesia on propulsive motility remains unclear, it seems reasonableto recommend its limited use in colon surgery.

Exakte Beschreibungen der postoperativen Motilität nach laparoskopischen Kolonresektionen im Vergleich zu offenen Eingriffen liegen nicht vor.